Action is needed this weekend! Take advantage of an opportunity to cut through some of the bureaucratic red tape that imperils the medical care of 57 million seniors. Actually, the regulations in question harm not only Medicare patients, but also put “commercially insured patients and their data under the agency’s control,” explains Dr. Kris Held.

CMS is seeking comments from the public on proposed changes to MACRA rules to be implemented in 2018.

Tell CMS to further widen exemptions from MACRA overregulation for physicians and their patients.

Comments are due by 11:59pm Eastern Daylight Time, Monday, August 21, and can be submitted online at the following link:

MACRA compliance is not compatible with patient-centered medical care. CMS must use all possible discretion authorized under law to free as many physicians as possible, and their patients, from this harmful overregulation. At the very least, practices with 15 physicians or fewer should be exempt from all MACRA penalties.

Additional details:

The U.S. Centers for Medicare & Medicaid Services (CMS) has released proposed changes to its so-called “Quality Payment Program” (QPP) rules for 2018. The QPP “implements provisions of the Medicare Access and CHIP Reauthorization Act (MACRA) related to the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (Advanced APMs).”

While initially created under the guise of increasing “quality” and “value,” in practice the program attempts to coerce doctors to comply with cookbook medicine and government rationing protocols while at the same time compromising patient privacy.

Fortunately, there are some new faces at CMS who understand the danger of this program and a few helpful changes have been proposed; however the changes don’t go nearly far enough. We are asking CMS to use all possible authority to lessen the burden on patients and physicians.

AAPS is not alone in calling for these needed changes. The Editorial Director of Medical Economicshas called on CMS to “Exempt all small practices from the program. … Smaller practices shouldn’t have to play the same game as the larger practices they already compete against every single day when it comes to things like patients, resources and payer influence. Don’t make the alleged ‘failures’ of small practices fund larger practice payment bonuses.”

Please submit your comments to CMS on this crucial issue before the Monday deadline.

Lack of price transparency is one of the biggest problems plaguing American patients and well-intentioned state legislators are now taking a stab legislative fixes.

But is a government mandate the right approach? Dr. Keith Smith, for one, warns that it isn’t. Here’s a recent example of just what can go wrong.

In one state, Ohio, the legislature passed a law now known as Ohio Revised Statute 5162.80, which has misdiagnosed the disease and has prescribed an ineffective and even potentially harmful cure, particularly for patients tied to an “insurance” plan.

On it’s face the bill seems straightforward: doctors and hospitals must give patients good faith estimates for charges and payments. Who could be opposed to that?

The devil is in the details, particularly in this section of the law:

A provider of medical services shall provide in writing before care is rendered: “The amount the health plan issuer intends to pay for the product, service, or procedure…”

Anyone who has ever tried to get an insurance company to divulge its contracted rates with providers prior to receiving care knows all too well what a herculean task it is.

To their credit, the bill’s authors included a provision to address this problem:

“Any health plan issuer contacted by a provider … shall provide such information to the provider within a reasonable time of the provider’s request.”

Again this looks like a reasonable provision at first glance, but it is really non-transparent transparency and worse could lead to delays in care.

Why should a patient have to contact a physician or facility to find out what his or her insurance plan will pay? This is in reality erecting a barrier between the patient and finding out what the actual costs for care will be at any given doctor or facility. It blocks meaningfully shopping for the best price.

We are not recommending government mandates, but a more effective requirement might be to demand that the insurers release ALL of their reimbursement rates, both in network and out-of-network, in a transparent manner so that everyone, particularly patients enrolled in a plan, can easily see how much the insurer would pay paying before a patient even sets foot in a doctors office.

The bill as written only requires that the insurers divulge the info on a case by case basis to the “provider.” Why not also to the patient? After all the patient is at least purportedly the actual customer of the insurance company.

As Dr. Michel Accad explains, price opaqueness is a symptom of larger problem, pervasive third-party-payment, and not in itself the root cause.

In a free and competitive healthcare market, price transparency would rarely be an issue, as it is not an issue in the market for cell phones and bubble gum. Doctors and hospitals could not survive without being upfront about fees. But, in its great wisdom, and supported by the sound logic of healthcare analysts and healthcare economists, the government has ensured—through its tampering with and participation in health insurance—that charges would be as opaque as possible.

As demonstrated by free market facilities like the Surgery Center of Oklahoma — who post their actual prices not fictitious chargemaster rates — the ultimate solution to not only price transparency, but increasing access to high quality, low cost care, is to kick out the middlemen driving up and obscuring the prices.

You’ve been told surgery required to repair a herniated disc has been denied; a mammogram to evaluate a new lump won’t be allowed; or you must be discharged from the hospital because an insurance company doctor you have never met will not approve further hospitalization.

As my patient’s advocate, I frequently must discuss their care with insurance doctors in peer-to-peer phone conversations. This is what I do starting this conversation: I get the doctor’s name; in what state they are licensed; their specialty; and tell them their name will be placed on the patient’s record as being a participant in medical decision-making.

With that, they must weigh their medical versus financial judgement, and know they might be subject to the same accountability I face. Does this make a difference? Sometimes.

Medical decision-making has been removed from your doctor and given to distant paper pushers of the insurance industry. Urge your physician in their peer-to-peer conversations to make insurance doctors responsible too.